Several antiretroviral drugs for people with HIV can cause elevated blood fats, which may increase the risk for cardiovascular disease. One of the therapies that has been tested for managing high cholesterol and triglycerides is fish oil, which has a long history of use to counter cardiovascular disease.
From the March 1, 2007 Journal of Acquired Immune Deficiency Syndromes: French researchers conducted a prospective, double-blind trial to assess the effect of N-3 polyunsaturated fatty acids — better known as omega-3 fatty acids — found in fish oil.The study included 122 HIV positive patients on HAART who still had elevated triglyceride levels (between 2 and 10 g/L) after a 4-week diet. Participants were randomly assigned to receive 2 capsules containing 1 g of fish oil (Maxepa) or else placebo capsules 3 times daily for 8 weeks, followed by an open-label phase during which all participants received fish oil. Ten individuals with baseline triglyceride levels above 10 g/L were not randomized and received open-label fish oil from the outset.
• The median triglyceride level decreased by 25.5% in the fish oil group, while rising by 1% in the placebo group.
•At week 8, the mean triglyceride levels were 3.4 and 4.8 g/L, respectively.
• Triglyceride levels normalized in 22.4% of subjects in the fish oil arm compared with 6.5% in the placebo arm (P = 0.013).
• 58.6% and 33.9%, respectively, experienced at least a 20% reduction in triglycerides (P = 0.007).
• Patients in the fish oil group experienced a slight decline in total cholesterol level, compared with a small increase in the placebo arm. • During the open-label phase, the decrease in triglycerides was sustained at week 16 for patients in the fish oil group, while those initially in the placebo group experienced a 21.2% decrease after switching to fish oil.
• The patients with baseline triglyceride levels above 10 g/L experienced a 43.6% decrease by week 8.
• No significant differences in adverse events were observed between the fish oil and placebo arms.
Conclusion “This study demonstrated the efficacy of [polyunsaturated fatty acids] to lower elevated triglyceride levels in treated HIV-infected hypertriglyceridemic patients. [N-3 polyunsaturated fatty acids] have a good safety profile.”“The place of polyunsaturated fatty acids in the armamentarium of treatment of metabolic disorders in HIV-infected patients needs to be further investigated with future prospective studies…”
CITATION: P De Truchis, M Kirstetter, A Perier, and others. Reduction in triglyceride level with N-3 polyunsaturated fatty acids in HIV-infected patients taking potent antiretroviral therapy: a randomized prospective study. JAIDS 44(3): 278-285. March 1, 2007.